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J Int AIDS Soc. 2015 Oct 14;18:20182. doi: 10.7448/IAS.18.1.20182. eCollection 2015.

Uptake and yield of HIV testing and counselling among children and adolescents in sub-Saharan Africa: a systematic review.

Author information

1
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; gdarsh@gmail.com.
2
Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
3
Biomedical Research and Training Institute, Harare, Zimbabwe.
4
Centre for Clinical Microbiology, University College London, London, United Kingdom.
5
HIV/AIDS Department, World Health Organization, Geneva, Switzerland.
6
Tingathe Outreach Program, Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
7
Department of Medicine, Baylor College of Medicine, Houston, TX, USA.

Abstract

INTRODUCTION:

In recent years children and adolescents have emerged as a priority for HIV prevention and care services. We conducted a systematic review to investigate the acceptability, yield and prevalence of HIV testing and counselling (HTC) strategies in children and adolescents (5 to 19 years) in sub-Saharan Africa.

METHODS:

An electronic search was conducted in MEDLINE, EMBASE, Global Health and conference abstract databases. Studies reporting on HTC acceptability, yield and prevalence and published between January 2004 and September 2014 were included. Pooled proportions for these three outcomes were estimated using a random effects model. A quality assessment was conducted on included studies.

RESULTS AND DISCUSSION:

A total of 16,380 potential citations were identified, of which 21 studies (23 entries) were included. Most studies were conducted in Kenya (n=5) and Uganda (n=5) and judged to provide moderate (n=15) to low quality (n=7) evidence, with data not disaggregated by age. Seven studies reported on provider-initiated testing and counselling (PITC), with the remainder reporting on family-centred (n=5), home-based (n=5), outreach (n=5) and school-linked HTC among primary schoolchildren (n=1). PITC among inpatients had the highest acceptability (86.3%; 95% confidence interval [CI]: 65.5 to 100%), yield (12.2%; 95% CI: 6.1 to 18.3%) and prevalence (15.4%; 95% CI: 5.0 to 25.7%). Family-centred HTC had lower acceptance compared to home-based HTC (51.7%; 95% CI: 10.4 to 92.9% vs. 84.9%; 95% CI: 74.4 to 95.4%) yet higher prevalence (8.4%; 95% CI: 3.4 to 13.5% vs. 3.0%; 95% CI: 1.0 to 4.9%). School-linked HTC showed poor acceptance and low prevalence.

CONCLUSIONS:

While PITC may have high test acceptability priority should be given to evaluating strategies beyond healthcare settings (e.g. home-based HTC among families) to identify individuals earlier in their disease progression. Data on linkage to care and cost-effectiveness of HTC strategies are needed to strengthen policies.

KEYWORDS:

HIV testing and counselling; adolescents; children; sub-Saharan Africa

PMID:
26471265
PMCID:
PMC4607700
DOI:
10.7448/IAS.18.1.20182
[Indexed for MEDLINE]
Free PMC Article

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